Promoting Speech, Language, and Literacy in Children Who Are Deaf or Hard of Hearing

Mary Pat Moeller, David J. Ertmer, Carol Stoel-Gammon, Mary Pat Moeller, David J. Ertmer, Carol Stoel-Gammon

• Editorial: Brookes Publishing
• Año: 2016
• ISBN:
  9781681250328
• Categoría: Medicina
• Categoría: Audiología y patología del habla

What are today's best interventions for supporting language acquisition and literacy for children who are deaf or hard of hearing (D/HH)? This comprehensive textbook-and-DVD set brings the answers to life for tomorrow's speech-language pathologists, audiologists, and educators. The newest addition to the respected Communication and Language Intervention (CLI) series, this important volume enlisted more than a dozen experts to present evidence-based intervention approaches, spanning the critical early years of language development through the complex reading and writing challenges of the school years. Chapters cover a continuum of available communication approaches—from auditory-focused to visually-focused to simultaneous use of speech and sign—while encouraging the use of individualized interventions to meet each child's needs. To prepare professionals for decades of effective, evidence-based practice, the included video clips demonstrate how to implement assessments and interventions and work successfully with children and families. CUTTING-EDGE INFORMATION ON

• audiological assessments and technological interventions for children
• principles and practices for family-centered early intervention
• understanding, supporting, and coaching families
• assessments to identify intervention priorities
• Theory of Mind
• auditory-verbal therapy and phonological interventions
• sign language and sign systems
• use of the internet to deliver intervention services
• elements of supportive early education environments
• approaches for optimizing reading and writing skills
• strategies for promoting social and academic success in integrated classrooms
• and much more

1

Promoting Language and Literacy Development in Children Who Are Deaf or Hard of Hearing

An Introduction

Mary Pat Moeller, David J. Ertmer, and Carol Stoel-Gammon

Children who are deaf or hard of hearing (D/HH) are adept learners with widely varied interests, talents, family backgrounds, hearing abilities, and specific needs. These diverse individual traits make the intervention process both challenging and engaging for service providers. One common and pressing need for children who are D/HH is that they have early and consistent access to rich language models in the environment. Access to linguistic input and communicative exchanges is known to be a critical factor that influences language development in children who hear (Hoff & Naigles, 2002; Hurtado, Marchman, & Fernald, 2008; Slobin, 1985) and is especially critical for children who are D/HH, who may experience reductions in quality and/or consistency of access to language exposure (Moeller & Tomblin, in press; Snow, 1994). Therefore, a central goal of interventions designed for children who are D/HH is the promotion of early and consistent communication access as a way of preventing or minimizing linguistic delays. Strategies for working toward these goals include the provision of 1) capacity-building supports for families, 2) linguistically rich environmental stimulation (either auditory, visual, or both), 3) well-fit and monitored hearing assistance technologies with focus on active promotion of auditory learning, and 4) effective early interventions that support families in implementing their chosen communication approach(es). The overall purpose of these strategies is to promote children’s establishment of strong language foundations in the early years to support later literacy and social language competence.

A NEW GENERATION OF CHILDREN WHO ARE DEAF OR HARD OF HEARING

Since the early 2000s, intervention needs of children who are D/HH could be described as a moving target—the landscape has changed dramatically and continues to change due to advancements in early identification, technology, and early service innovations. For service providers, this situation makes some previously familiar landmarks less recognizable and some tried and true intervention methods less applicable. As a result of early identification and changing technologies, providers are faced with the need to expand their knowledge and skill sets, including preparation for working across a wider range of ages (infants through young adults) and the management of complex technologies (e.g., cochlear implants, digital hearing aids, frequency-modulation [FM] systems). Children are served by intervention programs at much earlier ages than in the past, and early intervention services commonly begin in the first year of life, which requires a skill set for working within the context of the family system. In general, the service delivery process has shifted from emphasis on remedial approaches for late-identified children to preventative developmental approaches for those who are identified early. Prior to universal newborn hearing screening (UNHS), infants who were D/HH were often identified late, and this was especially true for infants who were hard of hearing (HH), typically identified at 2 years of age or later (Halpin, Smith, Widen, & Chertoff, 2010; Stein, Clark, & Kraus, 1983; Stein, Jabaley, Spitz, Stoakley, & McGee, 1990). Fortunately, studies confirm that early hearing screening has been effective in decreasing age of identification as well as the ages at which children receive follow-up care, such as confirmatory testing, enrollment in early intervention, and fitting of amplification devices (Dalzell et al., 2000; Durieux-Smith, Fitzpatrick, & Whittingham, 2008; Harrison, Roush, & Wallace, 2003; Holte et al., 2012; Spivak, Sokol, Auerbach, & Gershkovich, 2009; Vohr et al., 2008). Although some children are still identified late in the era of UNHS (Walker et al., 2014), this unfortunate situation occurs far less often than in the past, which alters the characteristics and experiences of families and children in ways that positively influence the nature of presenting intervention needs.

When early identification is linked efficiently with follow-up steps, families are placed in a proactive position, with opportunities to provide early linguistic stimulation (either auditory, visual, or both) that may minimize or prevent communicative delays. When early intervention services are effective with children and families, child outcomes are typically better than in the past (see Spencer & Marschark, 2006, for a review), and this positive shift has cascading effects, altering abilities and intervention needs at later stages in children’s development. To stay abreast of these advancements, service providers are challenged to gain new skills, understand the impact of children’s perceptual abilities on learning, rely less on past experiences, and remain current as children’s technology offers advanced features and opportunities. This situation presents a compelling rationale for developing a book focused on language and literacy interventions for children who are D/HH—as Bob Dylan crooned in the 1960s, “The times, they are a-changin’.”

Although the landscape is shifting, the need for an individualized approach to intervention endures. Children who are D/HH represent a heterogeneous group with highly varied outcomes, unique strengths, and individualized needs. Even when we see average outcomes improving for this group, studies consistently report wide ranges in individual outcomes; some children thrive and others struggle. What works for one child does not necessarily work for another. This makes it incumbent on the service provider to critically evaluate children’s responses to intervention and to alter strategies as needed to address individual needs. Recent advances allow many children who are D/HH to develop spoken language. However, varied approaches are required and desirable to address the diverse array of child and family needs, family communication choices, cultural values, and learning styles. It is recommended practice that service providers have the professional qualifications and core knowledge and skills to optimize child development and family well-being, “regardless of the route or routes taken by the family (e.g., spoken language, American Sign Language, visually-supported spoken language)” (Joint Committee on Infant Hearing [JCIH], 2013, p. e1328). Thus, for some children and families, the intervention process requires service providers that have highly specialized skills. For example, some interventions require fluency in American Sign Language (ASL), and some require specialized skills in early auditory development and management of cochlear implants.

Furthermore, it is estimated that 35%–40% of children who are D/HH are reported to have other conditions/disabilities (Gallaudet Research Institute, 2010; Yoshinaga-Itano, Sedey, Coulter, & Mehl, 1998), sometimes referred to as “D/HH plus.” The high incidence of special needs in this group of children adds to the need for expertise in developmental, medical, and communicative (e.g., augmentative) strategies on the part of service providers. Several authors in this book share challenging and interesting case studies in order to reinforce the concept that service providers must use diagnostically oriented interventions, keen observation, and careful tracking of responses to intervention to guide the adaptive intervention process and bring about successful outcomes with children who have complex developmental needs.

PURPOSES OF THIS BOOK

A primary goal of this book is to describe and critically examine a broad range of intervention approaches that are specifically designed for and/or commonly used with children who are D/HH. Principles of evidence-based practice are incorporated into each chapter. The American Speech-Language-Hearing Association (2005) defines the term evidence-based practice (EBP) as “an approach in which current, high-quality research evidence is integrated with practitioner expertise and client preferences and values into the process of making clinical decisions.” As part of these decision-making processes, service providers are expected to acquire and maintain knowledge and skills related to EBP to critically evaluate intervention approaches and the quality of evidence while incorporating new high-quality evidence into practice. Given these expectations, another key goal of this book is to support readers in gaining additional skills for critically examining intervention approaches and considering the evidence supporting them (or lack thereof). This is a tall order.

On a positive note, service innovations since the turn of the century have fueled opportunities for and interest in research on the outcomes of children who are D/HH. However, in some ways, technological progress has outpaced the garnering of evidence to support specific intervention approaches. We acknowledge at the outset that evidence supporting specific interventions for children who are D/HH is quite limited and, in some cases, only beginning to appear in literature. Comparative intervention studies are particularly rare. In spite of these constraints, efforts to purposefully integrate best available research evidence with practitioner expertise and client values and preferences are at the foundation of effective practice and are therefore endorsed and modeled throughout this text.

Children who are D/HH also benefit from many evidence-based interventions that were developed for children who hear. Thus, in the chapters that follow, authors describe widely implemented intervention approaches from the child language literature along with the evidence supporting them. When these approaches are implemented with children who are D/HH, they may require some specific adaptations that are based in service provider knowledge of the population and mastery of specialized skills. The authors have made every effort to describe their important insights regarding the process of adapting interventions and the unique skills that are required of the service provider.

Another purpose of this book is to provide comprehensive coverage of the diverse approaches that are typically implemented with children who are D/HH and their families. Some intervention practices for children who are D/HH are highly specialized and involve unique certifications or competencies (Listening and Spoken Language Specialist [LSLS]; bilingual-bicultural programs using American Sign Language). Other approaches adapt strategies that are designed for any child with speech- language challenges. Contributors to this book agree that a variety of strategies are often necessary, because it seems unlikely that a single approach will completely meet the wide array of auditory, visual, and communicative needs of the heterogeneous group of children who are D/HH. As editors, we have purposely recruited authors who present diverse intervention approaches that range on a continuum from primarily auditory focused to combined auditory-visual to primarily visually focused. We do so to promote understanding and evaluation of the specific interventions and to support the practice of individualization. The goal is not to polarize viewpoints but rather to present the varied strategies that are implemented singularly or in combination to support language development with this population. In reality, families may elect to use a variety of strategies and shift their emphasis based on the child’s changing abilities. Many families of this new generation of children focus on the development of spoken language, yet others incorporate sign language within bilingual approaches. Some families elect to incorporate cued speech, manual codes of English, augmentative approaches, or a combination of strategies to serve as bridges to the development of spoken language. Selected authors share how the intervention process is adapted when auditory, visual, or combined approaches are implemented. Importantly, the chapter on family-centered practices (Chapter 4) discusses the concepts of informed choice and strategies for supporting families who are navigating the complexities of decision making around communication. Our overall goal is to promote a comprehensive understanding of the unique needs of children who are D/HH along with contemporary practices that are designed to promote optimal outcomes.

ORGANIZATION OF THE BOOK

This book is organized into three main sections: Foundations of Intervention, Early Childhood Interventions, and Language and Literacy in the School Years. This organization reflects the developmental orientation of our work with children who are D/HH. These children may or may not present with persistent support needs throughout childhood, but regardless, their primary needs shift as linguistic skills develop and educational settings change. Intervention programs need to be developmentally appropriate, and there are distinct differences in the content focus of interventions for infants, preschoolers, and school-age children. Our overall organization respects how interventions change as children mature and service delivery settings shift (see Table 1.1).

Table 1.1. Developmental organization of topics covered in the book

Principles Guiding Individual Chapters

Several guiding principles (premises) influenced the selection of topics that are presented in the forthcoming chapters. These main premises are highlighted here as we orient the reader to the content that is emphasized in the individual chapters and sections.

Premise 1 Ongoing audiological management (Chapter 2) and provision of family supports (Chapter 3) are considered foundational to all service provision for children who are D/HH and their families. Although some families may not elect amplification for their children, all families interface with audiological services, and the majority receive ongoing services related to monitoring of auditory thresholds, fitting and verification of amplification, and/or mapping of cochlear implants. It is essential that service providers for children who are D/HH master and apply audiological principles and work in partnership with the audiologist to optimize the child’s reliance on and consistent use of devices. Recent evidence supports the practices of early device fitting and optimizing the child’s auditory access (audibility). Longitudinal studies demonstrate that age of fitting/implantation (Nicholas & Geers, 2007; Sininger, Grimes, & Christensen, 2010) and the amount of audibility provided by hearing aids (Stiles, McGregor, & Bentler, 2012; Tomblin, Oleson, Ambrose, Walker, & Moeller, 2014) contribute to child outcomes. Recent evidence also suggests that consistency of device use improves during the preschool years but is most variable in toddlers, less-educated families, and children with hearing thresholds in the mild range (Walker et al., 2013). We began this chapter with an emphasis on access to linguistic input. For the majority of children using amplification devices, verified high-quality fittings (McCreery, Bentler, & Roush, 2013), optimal audibility, and consistent device use are our first line of defense in supporting linguistic access for children learning spoken language.

Effective family support is known to be an influential aspect of intervention (Calderon & Greenberg, 1999) that is valued by families both early (Global Coalition of Parents of Children Who Are D/HH, 2010) and throughout the course of the child’s development. In a recent qualitative study, families of newly identified children reported gaps in Early Hearing Detection and Intervention systems in the areas of social services and parent support (Fitzpatrick, Angus, Durieux-Smith, Graham, & Coyle, 2008). Chapter 3 introduces multidisciplinary perspectives from social work on the topic of family support. The authors consider four theoretical models for understanding parental and family experie...